Background In order to understand how current surgical residents feel about their training, a survey focused on perceptions regarding early entry into a subspecialty and the adequacy of training was ...sent to selected residency programs in general surgery (GS). Study Design A 36-item online anonymous survey was sent to the program directors of 55 GS programs. The national sample consisted of 1,515 PGY 1 to PGY 5 categorical residents. Results The response rate was 45%. Overall, 80% were planning on pursuing a fellowship. The majority (63%) believed that the Residency Review Committee for Surgery and the American Board of Surgery should consider the shift to early subspecialty training. Almost 70% of respondents preferred a 3-year basic track followed by a 3-year subspecialty track. In response to the survey item, “Do you think a 5-year GS residency fully prepares you to practice GS?”, 38% of residents overall responded “no” or “unsure.” This figure decreased with each increasing year of residency training, from PGY 1 (53.3%) to PGY 5 (23%). Finally, 71% of residents who answered “no” or “unsure” to the above question believe there should be a change to a track system. Conclusions The choice of fellowship training for 80% of trainees partially reflects that 38% are not confident about their skills with 5 years of training in GS, including 23% of graduating chief residents. Training and certifying groups should update and strengthen the current curriculum for categorical residents in GS and continue their efforts to offer shortened independent or integrated residency training for those who will enter surgical specialties. Innovative solutions are needed to solve the logistic and financial problems involved.
Abstract
With the recent radioastronomical detection of
cis-trans-
carbonic acid (H
2
CO
3
) in a molecular cloud toward the Galactic center, the more stable but currently unobserved
cis-cis
...conformer is shown here to have strong IR features. While the higher-energy
cis-trans-
carbonic acid was detected at millimeter and centimeter wavelengths, owing to its larger dipole moment, the vibrational structure of
cis-cis-
carbonic acid is more amenable to its observation at micron wavelengths. Even so, both conformers have relatively large IR intensities, and some of these fall in regions not dominated by polycyclic aromatic hydrocarbons. Water features may inhibit observation near the 2.75
μ
m hydride stretches, but other vibrational fundamentals and even overtones in the 5.5–6.0
μ
m range may be discernible with JWST data. This work has employed high-level, accurately benchmarked quantum chemical anharmonic procedures to compute exceptionally accurate rotational spectroscopic data compared to experiment. Such performance implies that the IR absorption and even cascade emission spectral features computed in this work should be accurate and will provide the needed reference for observation of either carbonic acid conformer in various astronomical environments.
We obtained accurate vibrational frequencies, rotational constants, and vertical transition energy for AlNH2(X1A1) and HAlNH(X1A′) isomers using ab initio calculations at various levels of theory. ...These two isomers are potential candidates for astronomical observation. AlNH2 and HAlNH are thermodynamically stable, with Al-NH2 and HAl-NH bond dissociation energies predicted to be 4.39 and 3.60 eV, respectively. The two isomers are characterized by sizable dipole moments of 1.211 and 3.64 D, respectively. The anharmonic frequencies and spectroscopic constants reported for the two isomers should facilitate their experimental differentiation. In addition, we evaluated the evolution of the low-lying electronic states along the stretching coordinates, as well as the absorption cross sections. AlNH2 absorbs strongly around 287, 249, and 200 nm, whereas the HAlNH absorption is centered around 370 and 233 nm.
Rheumatoid arthritis (RA) is commonly associated with pulmonary disease that can affect any anatomic compartment of the thorax. The most common intrathoracic manifestations of RA include interstitial ...lung disease, airway disease, pleural disease, rheumatoid nodules, and drug-induced toxicity. Patients with RA with thoracic involvement often present with nonspecific respiratory symptoms, although many are asymptomatic. Therefore, clinicians should routinely consider pulmonary disease when evaluating any patient with RA, particularly one with known risk factors. The optimal screening, diagnostic, and treatment strategies for RA-associated pulmonary disease remain uncertain and are the focus of ongoing investigation.
Recessive Stargardt disease (STGD1) is an inherited blinding disorder caused by mutations in the Abca4 gene. ABCA4 is a flippase in photoreceptor outer segments (OS) that translocates retinaldehyde ...conjugated to phosphatidylethanolamine across OS disc membranes. Loss of ABCA4 in Abca4
−/− mice and STGD1 patients causes buildup of lipofuscin in the retinal pigment epithelium (RPE) and degeneration of photoreceptors, leading to blindness. No effective treatment currently exists for STGD1. Here we show by several approaches that ABCA4 is additionally expressed in RPE cells. (i) By in situ hybridization analysis and by RNA-sequencing analysis, we show the Abca4 mRNA is expressed in human and mouse RPE cells. (ii) By quantitative immunoblotting, we show that the level of ABCA4 protein in homogenates of wild-type mouse RPE is about 1% of the level in neural retina homogenates. (iii) ABCA4 immunofluorescence is present in RPE cells of wild-type and Mertk
−/− but not Abca4
−/− mouse retina sections, where it colocalizes with endolysosomal proteins. To elucidate the role of ABCA4 in RPE cells, we generated a line of genetically modified mice that express ABCA4 in RPE cells but not in photoreceptors. Mice from this line on the Abca4
−/− background showed partial rescue of photoreceptor degeneration and decreased lipofuscin accumulation compared with nontransgenic Abca4
−/− mice. We propose that ABCA4 functions to recycle retinaldehyde released during proteolysis of rhodopsin in RPE endolysosomes following daily phagocytosis of distal photoreceptor OS. ABCA4 deficiency in the RPE may play a role in the pathogenesis of STGD1.
We designed a robotic fish caudal fin with six individually moveable fin rays based on the tail of the bluegill sunfish, Lepomis macrochirus. Previous fish robotic tail designs have loosely resembled ...the caudal fin of fishes, but have not incorporated key biomechanical components such as fin rays that can be controlled to generate complex tail conformations and motion programs similar to those seen in the locomotor repertoire of live fishes. We used this robotic caudal fin to test for the effects of fin ray stiffness, frequency and motion program on the generation of thrust and lift forces. Five different sets of fin rays were constructed to be from 150 to 2000 times the stiffness of biological fin rays, appropriately scaled for the robotic caudal fin, which had linear dimensions approximately four times larger than those of adult bluegill sunfish. Five caudal fin motion programs were identified as kinematic features of swimming behaviors in live bluegill sunfish, and were used to program the kinematic repertoire: flat movement of the entire fin, cupping of the fin, W-shaped fin motion, fin undulation and rolling movements. The robotic fin was flapped at frequencies ranging from 0.5 to 2.4 Hz. All fin motions produced force in the thrust direction, and the cupping motion produced the most thrust in almost all cases. Only the undulatory motion produced lift force of similar magnitude to the thrust force. More compliant fin rays produced lower peak magnitude forces than the stiffer fin rays at the same frequency. Thrust and lift forces increased with increasing flapping frequency; thrust was maximized by the 500× stiffness fin rays and lift was maximized by the 1000× stiffness fin rays.
Background This study attempts to validate the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for spleen, liver, and kidney injuries using the National Trauma Data ...Bank (NTDB). Study Design All NTDB entries with Abbreviated Injury Scale codes for spleen, liver, and kidney were classified by OIS grade. Injuries were stratified either as an isolated intraabdominal organ injury or in combination with other abdominal injuries. Isolated abdominal solid organ injuries were additionally stratified by presence of severe head injury and survival past 24 hours. The patients in each grading category were analyzed for mortality, operative rate, hospital length of stay, ICU length of stay, and charges incurred. Results There were 54,148 NTDB entries (2.7%) with Abbreviated Injury Scale–coded injuries to the spleen, liver, or kidney. In 35,897, this was an isolated abdominal solid organ injury. For patients in which the solid organ in question was not the sole abdominal injury, a statistically significant increase (p ≤ 0.05) in mortality, organ-specific operative rate, and hospital charges was associated with increasing OIS grade; the exception was grade VI hepatic injuries. Hospital and ICU lengths of stay did not show substantial increase with increasing OIS grade. When isolated organ injuries were examined, there were statistically significant increases (p ≤ 0.05) in all outcomes variables corresponding with increasing OIS grade. Severe head injury appears to influence mortality, but none of the other outcomes variables. Patients with other intraabdominal injuries had comparable quantitative outcomes results with the isolated abdominal organ injury groups for all OIS grades. Conclusions This study validates and quantifies outcomes reflective of increasing injury severity associated with increasing OIS grades for specific solid organ injuries alone, and in combination with other abdominal injuries.
Abstract
A first look is taken at the NIRSpec 1–5
μ
m observations from James Webb Space Telescope program 1591 that targets seven objects along the low-mass stellar life cycle with polycyclic ...aromatic hydrocarbon (PAH) emission. Spectra extracted from a 1.″5 radius circular aperture are explored, showing a wealth of features, including the 3
μ
m PAH complex, the PAH continuum, and atomic and molecular emission lines from H
i
, He, H
2
, and other species. CO
2
- and H
2
O-ice absorption and CO emission is also seen. Focusing on the bright-PDR position in M17, the PAH CH stretch falls at 3.29
μ
m (FWHM = 0.04
μ
m). Signs of its 1.68
μ
m overtone are confused by line emission in all targets. Multicomponent decomposition reveals a possible aliphatic deuterated PAH feature centered at 4.65
μ
m (FWHM = 0.02
μ
m), giving D/H
alip.
= 31% ± 12.7%. However, there is little sign of its aromatic counterpart between 4.36 and 4.43
μ
m. There is also little sign of PAH nitrile emission between 4.34 and 4.39
μ
m. A PAH continuum rises from ∼1 to 3.2
μ
m, after which it jumps by about a factor of 2.5 at 3.6
μ
m, with bumps at 3.8, 4.04, and 4.34
μ
m adding structure. The CO
2
absorption band in M17 is matched with 10:1 H
2
O:CO
2
ice at 10 K. The
v
= 0 pure rotational molecular hydrogen population diagram reveals >2200 K UV-pumped gas. The hydrogen Pfund series runs from levels 10 to >30. Considering Br
α
/Br
β
= 0.381 ± 0.01966 and Case B recombination results in
A
V
≃ 8. CO emission in IRAS 21282+5050 originates from 258 K gas. In-depth spectral–spatial analysis of all features and targets is planned for a series of forthcoming papers.
Studies indicate that West African and Congo basin isolates of monkeypox virus (MPXV) are genetically distinct. Here, we show Congo basin MPXV-ZAI-V79 is more virulent for cynomolgus monkeys as ...compared to presumed West African MPXV-COP-58. This finding may explain the lack of case-fatalities in the U.S. 2003 monkeypox outbreak, which was caused by a West African virus. Virulence differences between West African and Congo basin MPXV are further supported by epidemiological analyses that observed a similar prevalence of antibodies in non-vaccinated humans in both regions, while >90% of reported cases occurred in the Congo basin, and no fatal cases were observed outside of this region. To determine the basis for this difference in virulence, we sequenced the genomes of one human West African isolate, and two presumed West African isolates and compared the sequences to Congo basin MPXV-ZAI-96-I-16. The analysis identified D10L, D14L, B10R, B14R, and B19R as possible virulence genes, with D14L (ortholog of vaccinia complement protein) as a leading candidate.
Hyaluronic acid (HA), an extracellular matrix component, is degraded in response to local tissue injury or stress. In various animal models of lung injury, HA has been shown to play a mechanistic ...role in modulating inflammation and injury. While HA is present in the lungs of patients with acute respiratory distress syndrome (ARDS), its relationship to patient outcomes is unknown.
We studied 86 patients with ARDS previously enrolled in the Phase II Randomized Trial of Fish Oil in Patients with Acute Lung Injury (NCT00351533) at five North American medical centers. We examined paired serum and bronchoalveolar lavage fluid (BALF) samples obtained within 48 hours of diagnosis of ARDS. We evaluated the association of HA levels in serum and BALF with local (lung injury score (LIS)) and systemic (sequential organ failure assessment score (SOFA)) measures of organ dysfunction with regression analysis adjusting for age, sex, race, treatment group, and risk factor for ARDS.
We found that both day-0 circulating and alveolar levels of HA were associated with worsening LIS (p = 0.04 and p = 0.003, respectively), particularly via associations with degree of hypoxemia (p = 0.02 and p < 0.001, respectively) and set positive end-expiratory pressure (p = 0.01 and p = 0.02, respectively). Circulating HA was associated with SOFA score (p < 0.001), driven by associations with the respiratory (p = 0.02), coagulation (p < 0.001), liver (p = 0.006), and renal (p = 0.01) components. Notably, the alveolar HA levels were associated with the respiratory component of the SOFA score (p = 0.003) but not the composite SOFA score (p = 0.27).
Elevated alveolar levels of HA are associated with LIS while circulating levels are associated with both lung injury and SOFA scores. These findings suggest that HA has a potential role in both local and systemic organ dysfunction in patients with ARDS.
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